Lung Cancer Survival High for Patients With Early, Screen-Detected Tumors

CHICAGO — The diagnosis of early-stage lung cancer with low-dose CT (LDCT) screening led to high rates of lung cancer-specific survival two decades later, according to I-ELCAP data.

The 20-year lung cancer-specific survival rate was 80% for the 1,285 I-ELCAP participants diagnosed with early-stage disease, reported Claudia Henschke, MD, PhD, of Mount Sinai Icahn School of Medicine in New York City, at the Radiological Society of North America (RSNA) annual meeting.

She also reported 100% lung cancer-specific survival rates for the 139 participants with non-solid cancerous lung nodules and the 155 patients with nodules of part-solid consistency, and a rate of 73% for the 991 participants with solid nodules.

The estimated lung cancer-specific survival for clinical stage IA lung cancers, and for resected pathologic stage IA lung cancers measuring ≤10 mm in average diameter of length and width on the same CT image, was 86%, regardless of consistency. For participants with pathologic stage IA cancers of ≤10 mm, the 20-year lung cancer-specific survival rate was 92%, Henschke stated.

The current study builds on findings from 2006, when I-ELCAP researchers identified a 10-year lung cancer-specific survival rate of 88% for early-stage disease found on LDCT screening.

Henschke told MedPage Today that although lung cancer screening has now been accepted as life-saving therapy, “only about 15% of the people who are eligible to undergo screening are being screened.” She noted that the radiation dose used to screen people for lung cancer is about 10% of the dose used in most mammograms.

“We have made progress in screening, because at the time we started this, there was no screening at all,” she said. “But we still have a long way to go.”

Henschke suggested that there are numerous reasons that lung cancer screening has not caught on with more patients and clinicians, the main being a widespread belief that if lung cancer is detected there isn’t much one can do about it, and that the treatment is draconian.

“But we are now finding new surgical and radiation treatments that are far less invasive than major lung surgeries,” she said. “And we now have the proof that lung-cancer specific survival for 20 years or more is possible for the vast majority of patients.”

Henschke said that she and her colleagues are continuing to follow the patients in the I-ELCAP study, and they are still enrolling patients in screening protocols. “We are hoping that our work will allow us to expand the treatment guidelines,” she said.

The average 5-year lung cancer survival rate is 18.6%, with less then one in five tumors diagnosed at an early stage, according to the American Lung Association, and more than half of people with lung cancer die within a year of being diagnosed.

The U.S. Preventive Services Task Force (USPSTF) currently recommends annual LDCT screening in those ages 50-80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. However, a recent study showed lackluster uptake of LDCT screening among patients who are eligible per USPSTF guidance.

Max Wintermark, MD, of MD Anderson Cancer Center in Houston, told MedPage Today that “when we discuss screening or vaccination, there is always concern about what you are doing, or if what you are doing is worthwhile.”

“It is nice to have these kinds of data to guide [patients]…Obviously, if you have lung cancer, this early stage is when you want to be diagnosed, because we can do something about it,” added Wintermark, who was not involved in the study.

The International Early Lung Cancer Action Program (I-ELCAP) was started in 1992 with the goal of advancing LDCT screening. The multi-institution, multi-national research program has enrolled more than 87,000 participants from over 80 institutions.